tbuckley/cabot-search huggingface dataset:
AB0500 STUDY OF THE USE AND PRESCRIPTION OF ANALGESICS DURING RHEUMATOID ARTHRITIS (RA)
Authors: A. Rafi, Z. Baba, S. Zniber, A. Mougui, I. El Bouchti
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> In rheumatoid arthritis, pain is the major complaint for patients. Analgesic drugs are considered adjuvant treatments and their prescription is generally left to the patient's discretion. <h3>Objectives</h3> The objective was to determine the actual use of analgesics during RA. <h3>Methods</h3> This is a 5-month cross-sectional survey including patients with rheumatoid arthritis, meeting the ACR/EULAR 2010 criteria consulted during the study period were included The use of analgesics was evaluated via a questionnaire with 14 questions. Data was processed by statistical analysis using SPSS 2021 Software. <h3>Results</h3> There are 168 patients, including 24 men and 144 women. The average age was 49.91± 12.96 [20–90]. The average age at onset was 41.69 ±14.65. The average age of diagnosis for RA was 47.17 ±13.71 years. The average DAS28 was 5.32 ±1.35. Only 89 patients were taking analgesics The majority of patients were on disease modifying drug (DMARD) (78%), 145 (86%) were on corticosteroids, 46 (27.38%) were on non-steroidal anti-inflammatory drugs and 89 (53%) were taking analgesics. At the time of the survey 79 patients were not taking analgesics, 69 patients were taking a Tier 1 analgesic, 20 patients were taking a Tier 2 analgesic, none of the patients were taking a Tier 3 analgesic. Analgesics were never used alone. The difference between a pure analgesic and a non-steroidal anti-inflammatory was only known by 45 patients (27%). The difference between central and peripheral analgesic was only known by 15 patients (9%). For only 25 patients, analgesics were effective on diurnal pain in 25 patients and for 64 patients (72%) on nocturnal pain. Only 14 patients, or 15% were taking pain relievers at a fixed time, 60 (67%) only during flare-ups, and 15 (16%) were taking pain relievers at a fixed time with increased dose in case of flare-ups. The prescription of analgesics was the fact of the rheumatologist in 89% of cases, and self-medication in only 11% of cases. <h3>Conclusion</h3> In RA, as in all chronic painful diseases involving functional prognosis, pain is the essential symptom to treat. In our study the use of analgesics was 53%. <h3>References</h3> [1]Boureau F. etBoccard E.: Etude contrôlée versus placebo de l'efficacité antalgique d'une association paracétamol 500 mg codéine 30 mg dans la polyarthrite rhumatoïde.Rhumatologie 46, 157–163, 1994. [2]Brooks B.M., Dougan M.A., Mugford S. andMeffin E.: Comparative effectiveness of 5 analgesics in patients with rheumatoid arthritis and osteoarthritis.J. Rheumatol. 9, 723–6, 1982. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0551 INTRAVENOUS IMMUNOGLOBULIN IN PREGNANT WOMEN WITH SEVERE ACTIVE LUPUS: A CASE SERIES
Authors: J. Cajamarca-Baron, C. Sanmiguel Reyes, E. Bedoya, A. Lamos, S. Rivadeneira Chamorro, D. Guevara, A. Arredondo, H. Cubides, A. Rojas-Villarraga, A. Escobar
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Evidence on the management of pregnant patients with lupus activity is limited. The choice of pharmacological treatment is decisive for an adequate outcome. <h3>Objectives</h3> To show the experience of management with intravenous immunoglobulin (IVIG) in pregnant patients with severe active lupus. <h3>Methods</h3> Case series from January 2020 to November 2022 of pregnant patients being managed with IVIG in a hospital in Bogotá, Colombia. <h3>Results</h3> Out a total of 33 pregnant patients evaluated during the period, three cases of the use of IVIG in pregnant patients with severe lupus were found (Figure 1). The main involvement of lupus was renal (increased proteinuria), hematological (thrombocytopenia) and vascular [Intrauterine growth restriction (IUGR) and threatened abortion]. Average age was 30.3 years. One of the patients was diagnosed de novo with the disease during pregnancy, IVIG was given due to thrombocytopenia with resolution, but she presented fetal loss due to sepsis, in addition she had maternal vascular complications due to polyautoimmunity with antiphospholipid syndrome. The other two patients underwent IVIG at 24 weeks, one of them reached week 30 without considering new immunoglobulin applications, in the second case due to persistent proteinuria she received two additional cycles reaching 33 weeks of gestation. In both cases, a cesarean section was performed by IUGR at 30 and 33 weeks respectively. There were no complications associated with the newborns, with good response to proteinuria and resolution of cytopenias (See Table 1). There were no adverse drug events reported in any case. <h3>Conclusion</h3> IVIG can be a useful medication for the treatment of severe active lupus in pregnant patients, mainly in those with renal and hematological involvement. It is important to highlight IVIG has high safety and few side effects, on the mothers with lupus and their offspring's. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0405 NO DIFFERENCE IN RISK OF MYOCARDIAL INFARCTION AMONG PATIENTS RECEIVING EITHER IL6 OR TNF INHIBITORS FOR RHEUMATOID ARTHRITIS
Authors: Z. Tian, L. Kearsley-Fleet, K. Lauper, S. Haughton, K. Watson, M. Lunt, J. Mclaughlin, A. Verma, K. Hyrich
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Interleukin 6 inhibitors (IL-6i) can increase LDL cholesterol levels, which raises concerns about the risk of myocardial infarction (MI) in patients with rheumatoid arthritis (RA) receiving this therapy. <h3>Objectives</h3> This study aims to compare the risk of MI between people with RA in the UK clinical setting receiving IL-6i or tumour necrosis factor inhibitors (TNFi) overall or by line of therapy (LoT). <h3>Methods</h3> Patients with RA registered between 01/10/2001 and 30/05/2022 with BSRBR-RA starting IL-6i or TNFi treatments were included. Occurrence of MI was identified from clinical follow-up forms and through cause of death reported by the national UK death register. Only those MIs occurring whilst patient was actively receiving drug were included. The risk of MI in patients receiving IL6i compared to TNFi was compared using Cox regression, adjusted for baseline co-variates using propensity scores (PS, see Table 1). Follow-up commenced at the start of the drug of interest and patients were censored at occurrence of MI, death, discontinuation of therapy or last follow-up visit, whichever came first. Multiple imputation was used for missing data. To account for known differences in LoT use of TNFi and IL6i (with IL6i more likely as a later line bDMARD), overall analyses adjusted for LoT in PS and secondary analyses by LoT were conducted. Direct switches between originator to biosimilars were considered the same treatment. <h3>Results</h3> A total of 30,022 IL6i or TNFi LoTs in 20,898 patients were included (3,278 IL-6i; 26,744 TNFi), representing 119,797 person-years of exposure. Compared to patients receiving TNFi, patients starting IL-6i treatment were older, had longer disease duration, less likely to use methotrexate and steroids, and had more comorbidities. During follow-up, 409 MIs occurred, 30 on IL-6i and 379 on TNFi. After PS adjustment, the risk of MI was not significantly different between the two treatment overall (HR 0.87, 95% CI 0.56-1.37) or when stratified by LoT (Table 1). <h3>Conclusion</h3> This study could not identify any difference in risk of MI between IL-6i and TNFi treatment after patient characteristics and LoT were considered. <h3>Reference</h3> [1]Atzeni, F., Rodríguez-Carrio, J., Popa, C. D., Nurmohamed, M. T., Szűcs, G. &amp; Szekanecz, Z. (2021). 'Cardiovascular effects of approved drugs for rheumatoid arthritis', Nat Rev Rheumatol. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Zixing Tian: None declared, Lianne Kearsley-Fleet: None declared, Kim Lauper: None declared, Sally Haughton: None declared, Kath Watson: None declared, Mark Lunt: None declared, John Mclaughlin: None declared, Arpana Verma: None declared, Kimme Hyrich Consultant of: Honoraria from Abbvie, Grant/research support from: Grant income from Pfizer and BMS.
AB0532 THE USE OF BDMARDS IS ASSOCIATED WITH A LOWER PREVALENCE OF BILATERAL CAROTID PLAQUE IN PSA
Authors: D. Á. Galarza-Delgado, I. J. Colunga-Pedraza, J. R. Azpiri-López, N. De Avila Gonzalez, V. M. Beltran-Aguilar, V. Gonzalez-Gonzalez, A. G. Arias Peralta, J. A. Cardenas-de la Garza
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Psoriatic arthritis (PsA) is an autoimmune rheumatic disease (ARD) [1]. PsA have excessive cardiovascular risk (CVR) because of systematic inflammation that triggers endothelial dysfunction, which in turn induces atherosclerosis and CV disease [2]. Possible beneficial effects of biologic disease modifying antirheumatic drugs (bDMARDs) in patients with ARDs have been seen, particularly those with rheumatoid arthritis. Treatment with TNF inhibitors seems to improve endothelial dysfunction and atherosclerosis [3]. <h3>Objectives</h3> To evaluate the presence of carotid disease in patients with PsA using biologics or non-biologics. <h3>Methods</h3> This was a cross-sectional, descriptive study. PsA patients aged 40-75 years, who fulfilled the 2006 CASPAR criteria were recruited. Carotid ultrasound was performed on all study participants, and the presence of carotid plaque (CP), defined as carotid intima-media thickness (cIMT) ≥1.2mm or focal thickness ≥0.5mm, was assessed. Patients were divided into 2 groups according to whether they use bDMARDs or not. Comparisons were done with Chi-square test, Student´s T test and Mann-Whitney's U-test. A p-value ≤0.05 was considered significant. <h3>Results</h3> A total of 67 patients were recruited. Demographic characteristics are shown in Table 1. Twenty-seven were under bDMARD treatment, twenty-five of these were using an anti-TNF. We found a difference in C-reactive protein (CRP) levels (p=0.004), lower in patients with bDMARDs and in the presence of bilateral CP (p=0.041), less prevalent in patients with bDMARDs. The rest of the variables studied did not show significant differences. <h3>Conclusion</h3> We found that PsA patients under bDMARDs therapy had lower levels of CRP and less prevalence of bilateral CP in PsA, therefore strengthens the theory that the less inflammation the less bilateral carotid plaque is present. <h3>References</h3> [1]Gottlieb A, Merola JF. Psoriatic arthritis for dermatologists. Vol. 31, Journal of Dermatological Treatment. Taylor and Francis Ltd.; 2020. p. 662–79. [2]Gialouri CG, Fragoulis GE. Cardiovascular disease in psoriatic arthritis: facts and unmet needs. Vol. 61, Rheumatology (United Kingdom). Oxford University Press; 2022. p. 1305–6. [3]Fragoulis GE, Soulaidopoulos S, Sfikakis PP, Dimitroulas T, Kitas GD. Effect of Biologics on Cardiovascular Inflammation: Mechanistic Insights and Risk Reduction. J Inflamm Res. 2021 May;Volume 14:1915–31. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0508 EFFICACY OF SULFASALAZINE MONOTHERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS WHO HAD FACTORS ASSOCIATED WITH PREFERENCE FOR SULFASALAZINE OVER METHOTREXATE AS THE FIRST-LINE DRUG
Authors: K. Hattori, Y. Kanayama
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Methotrexate (MTX) is the first-line drug in treating patients with rheumatoid arthritis (RA) [1], while some patients have baseline factors and comorbidities which discourage use of MTX. While treatment with sulfasalazine (SSZ) is often performed in these cases, the efficacy of SSZ monotherapy was not well evaluated using recent disease activity assessment measures such as DAS28-CRP, CDAI and HAQ-DI. <h3>Objectives</h3> The aim of this research is to evaluate the efficacy of SSZ monotherapy in RA patients who had baseline factors and comorbidities associated with preference for SSZ over methotrexate as the first-line drug. <h3>Methods</h3> 78 treatment-naïve RA patients who started treatment with SSZ were included. We compared outcomes of SSZ monotherapy in patients with and without each of the following baseline factors and comorbidities: age 75 years or more, seronegative RA, moderate disease activity or less (DAS28-CRP, CDAI and HAQ-DI), and presence of comorbidities in lung, renal and liver. <h3>Results</h3> Baseline disease activity was higher among patients with 75 years old or more compared with those with under 75 years old (DAS28-CRP as 4.9 and 3.9, CDAI as 24 and 17 and HAQ-DI as 1.4 and 0.8), while those were similar at week 24 (DAS28-CRP as 3.3 and 3.2, CDAI as 14 and 12 and HAQ-DI as 0.8 and 0.5). There was no significant difference in disease activity at baseline and week 24 regardless seronegative or seropositive RA. There were also no significant differences in disease activity at baseline and week 24 regardless presence or absence of comorbidities in lung, renal and liver. Disease activity at week 24 tended to be high among patients with high disease activity at baseline comparing to those with moderate or less disease activity at baseline, whereas no statistically significant difference was observed (baseline DAS28-CRP as 5.0 and 3.3 and DAS28-CRP at week 24 as 3.5 and 2.9). <h3>Conclusion</h3> SSZ was similarly effective in treating elderly RA patients, patients with seronegative RA and RA patients with comorbidities in lung, renal and liver, comparing in treating those without any baseline factors and comorbidities. <h3>Reference</h3> [1]Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020;79:685-99. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0424 IMPACT OF BASELINE RHEUMATOID FACTOR TITERS AND ANTI-TNF MOLECULAR STRUCTURE ON THE RETENTION RATE IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: J. Calvo Gutierrez, R. Ortega Castro, M. C. Ábalos-Aguilera, F. J. Cepas, D. Ruiz, M. Rojas-Giménez, M. L. Ladehesa Pineda, A. Escudero Contreras, C. López-Medina
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatoid Factor (RF) is an antibody against the Fc portion of IgG forming immune complexes that contribute to the Rheumatoid Arthritis (RA) process. RF also binds the Fc region of many monoclonal antibodies (mAB), leading to lower drug levels and potential early withdrawal. Conversely, the absence of Fc portion in Certolizumab Pegol (PEG) may lead to a higher retention rate in comparison with other drugs in RA patients with higher RF titers. <h3>Objectives</h3> a) To evaluate the retention rate to any anti-TNF according to the baseline RF titers in patients with RA and b) to compare the retention rate to PEG vs. other anti-TNF in patients with high RF titers. <h3>Methods</h3> Longitudinal, retrospective and unicentre study including patients with a diagnosis of RA and treated with any anti-TNF (mAB (Adalimumab, Golimumab and Infliximab), fusion protein (Etanercept) or PEG (Certolizumab Pegol)) between 2007 and 2022. RF levels before anti-TNF initiation as well as the dates of both initiation and treatment withdrawal were collected. Log-rank test and Kaplan-Meier curves were conducted to evaluate the retention rate to the treatment in RF positive vs. negative, and between RF &lt;110 IU/ml vs RF ≥110 IU/ml (considering the median titre of RF (110 IU/ml) as the cut-off). In addition, the retention rate to each molecular structure were compared in patients with high RF titres (≥110 IU/ml). <h3>Results</h3> A total of 356 patients with RA treated with anti-TNF and with available titres of RF were included. Mean age was 52.0 (11.2) years and 80.1% were female. A total of 254 (71.3%) were RF positive. Retention rate to any anti-TNF was similar in RF- vs RF+ (median 4.30 vs. 3.91 years, p-value 0.580). However, considering the titres of RF, those with baseline RF ≥110 IU/ml showed a shorter retention rate in comparison with RF &lt;110 IU/ml (median 2.78 vs. 6.13 years, p=0.016). In patients with high RF titres (RF ≥110 IU/ml), a longer retention rate was found with PEG in comparison with fusion protein and mAB, although these differences were not significant (median 4.08 in PEG, 2.33 in fusion protein and 1.24 in mAB, respectively; p=0.460). <h3>Conclusion</h3> Higher RF titers before anti-TNF initiation were associated with a shorter retention rate in patients with RA. However, no differences were found between molecular structures, although patients treated with PEG seem to have a longer retention rate. These results confirm the possible effect of the RF in binding the Fc portion of the drug. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0444 SAFETY PROFILE OF BIOLOGICAL THERAPY IN RHEUMATOID ARTHRITIS IN MOROCCO. DATA FROM THE RBSMR
Authors: A. Kherrab, I. Chergaoui, A. Chbihi-Kaddouri, M. Ghazi, R. Abouqal, F. Allali, R. Bahiri, A. Bezza, I. El Bouchti, A. El Maghraoui, I. Ghozlani, H. Hassikou, T. Harzy, I. Hmamouchi, I. Linda, S. Janani, R. Niamane
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> In North African countries, few data are available on the safety of biotherapies. <h3>Objectives</h3> To evaluate safety of biological therapy (excluding infections) in a population with rheumatoid arthritis (RA) followed in the RBSMR (Registry of Biological therapies in rheumatic diseases of the Moroccan Society of Rheumatology). <h3>Methods</h3> This work was based on data from inclusion and 3 years of follow-up. It concerns 223 patients with RA receiving biotherapies, included between May 2017 and December 2018. safety was evaluated at inclusion and every 6 months for 3 years. Serious adverse events were defined as those that are life-threatening, that required hospitalization or permanent stopping of current biological agent. <h3>Results</h3> 223 patients were included in the study, the mean age was 51.8 ± 11.3 years, 87.4% were females, average duration of RA was 20.8 [13.9 - 31.3] months, The median duration of exposure to biotherapy was 3.1 [0 - 18.23] months. Patients were receiving anti-TNFα in 16.6% (37/223) of case, Rituximab (RTX) in 59.6% (133/223) and Tocilizumab (TCZ) in 23.8% (53/223). About 70% (155/223) of patients had an association with a csDMARDs. At inclusion, 19.73% (44/223) of patients had previously developed 59 adverse events (AEs) on current biotherapy. The 44 noninfectious AEs are occurred in 14.8% (33/223) of patients: 19 infusion reactions, 2 liver toxicities, 7 hematological disorders, 7 dyslipidemias and 9 other AEs. The global incidence of AEs was 24.81 per 100 patient-years (PA). The incidence of noninfectious AEs was 11.06 per 100 PA (Table I), The incidence of serious non-infectious AEs was 2.09 per 100 PA (n=14). The occurrence of noninfectious AEs differs depending the biological agent: anti-TNF=27% (10/37), RTX =27.3% (36/133) et TCZ =37.7% (20/53); with no statistically significant difference in frequency between these molecules (<i>p</i>=0,454). In logistic regression, no factors were associated with serious adverse events. The percentage of patients who changed their biological agent was 13.9% (31/223). During the 3 years of follow-up, 8 patients died, 4 of which by non-infectious AEs (lymphoma, heart rhythm disorder, unexplained deterioration of general condition, decompensated cirrhosis). Because of non-infectious AEs, biotherapy was discontinued in 3.58% (8/223) of patients. The percentage of patients lost to follow-up was 9.86% (22/223). <h3>Conclusion</h3> In RA, biological agents have a positive benefit/risk ratio. However, non-infectious side effects are not rare, they are multifactorial and can be potentially serious. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0413 COMPARISON OF THE EFFECTS OF TOCILIZUMAB AND TNF-Α INHIBITORS ON HEMOGLOBIN AND DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS PATIENTS WITH ANEMIA
Authors: H. Lee, S. K. Kim, S. H. Park, J. W. Kim, S. G. Kwak, J. Y. Choe
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatoid arthritis is a systemic disease with various extra-articular symptoms. Anemia is common comorbidity of RA. <h3>Objectives</h3> The purpose of this study is to compare the effect of tocilizumab and TNF-α inhibitors on hemoglobin changes and disease activity changes in RA patients. This study aims to determine whether tocilizumab is more effective in controlling hemoglobin elevation and disease activity in patients with anemia. <h3>Methods</h3> The data in this study derived from the Korean College of Rheumatology Biologics (KOBIO) registry. OF the patients registered in KOBIO registry, patients using tocilizumab and TNF-α inhibitors were enrolled in this study. To exclude the effects of previously used biologic DMARDs, patients who started the first biologic DMARDs and have been using one biologic DMARD for more than 1 year were included in this study. Anemia was defined as Hb levels &lt;12.0 g/dL in women and &lt;13.0 g/dL in men according to the World Health Organization (WHO) criteria at index date. <h3>Results</h3> Among rheumatoid arthritis patients with anemia, there were 126 patients in the tocilizumab group and 248 patients in the TNF-α inhibitor group. Initial and follow-up data collected after 1 year of biologic use were analyzed. After initiation of treatment, Hb and Hct were significantly elevated in tocilizumab group. Mean increases in Hb and Hct were 1.56 and 3.53 in tocilizumab group, 1.02 and 2.64 in TNF-α inhibitor group. DAS28-ESR and RAPID3 decreased significantly in tocilizumab group after using biologics. In tocilizumab group, DAS28-ESR decreased by 3.35 and RAPID3 decreased by 8.31. The changes in SJC, PGA, PhGA, SDAI and CDAI were not different between the two groups. Multivariate analysis was performed using the TNF-α inhibitor group as a control. Tocilizumab was more effective than TNF-α inhibitors in increasing Hb. <h3>Conclusion</h3> In RA patients with anemia, although tocilizumab was more effective than TNF inhibitors in increasing Hb, there was no difference between the two drugs in controlling disease activity. During the course of this research, the results of the DAS28-ESR and other outcome measures did not match. In patients treated tocilizumab, assessment of disease activity using the DAS28-ESR may be overestimated due to its effect on acute phase reactant values. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.